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What is an MCI ?What is an MCI ?
It is any incident where the number of patients and/or the severity of their injuries prohibits immediate patient care provided to all at that moment.
Multiple Casualty IncidentMultiple Casualty Incident
It will never happen to me right ?
High Risk/Low Frequency events
MCI Events in King County:MCI Events in King County: Highland Ice Arena, Shoreline: 76 patients
from a CO leak .Chlorine leak at a County Pool, 26 Patients School bus accident in Redmond 60 patientsSeveral MVA’s ranging from 5 to 10 PatientsSeattle Aurora Bridge Bus Incident. 33
Patients.
Common Problems at an MCICommon Problems at an MCI
Personnel not fully understanding their roles in an MCI setting.
Failure to identify the incident as an MCIFailure to triage properlyImproper numbering of treatment tags /Pt’sInappropriate, time consuming treatment Clogging at the transportation site.
Problems…Problems…
Scene access problemsIneffective response plan for the size of
incident.Lack of a large equipment cache on handCongested treatment areasTransport vehicles left unattended
Misconceptions of MCI:Misconceptions of MCI:
Every MCI requires a Medical Group to be set up. I.C. does not need an “Medical Group Supervisor”
in a large event. You cannot down grade a patient once they have
been triaged. All Immediate or red patients must be transported
first. Patients have to go the the closest Hospital. Yellow patients equal BLS patients always.
Multiple Casualty Definitions:Multiple Casualty Definitions:
Ambulance Staging Staging Manager Colored flagging Tape Funnel Point Hospital Control Medical group
Supervisor or Branch director
Medical Support Unit
Morgue area Plan C Triage Tracking Boards Treatment Area Transport Area Treatment Tags Triage Belt
Incident Management SystemIncident Management System
MCI plan is based on the same principles of the IMS system.
Allows for creation of an organizational structure for the most effectiveness of resources, personnel and equipment.
Span of control 3 to 7 with optimal being 5Is a “Medical Group” or “Medical Branch”
needed to effectively manage the incident ?
Activation of an MCIActivation of an MCI
Incident Commander’s responsibility to declare an MCI and provide a verbal size up of the incident.
Additional resources should be requested early on by the I.C.
The I.C. or designee is responsible for initial “Hospital Control” contact and plan activation.
Activation of Hospital ControlActivation of Hospital Control
Request “Activation of the MCI Hospital Control Plan” done by the I.C.
Transportation Team Leader communicates with Hospital Control
PRIMARY: Harborview Medical Center Ask for the “Charge Nurse” This will result in notification of HMC E.R. staff,
HMC Physician portable 55, and area Hospitals if necessary.
Is a “Lock Down” needed at local Hospitals ?
Secondary Hospital ControlSecondary Hospital Control
Overlake Medical CenterRequest Charge Nurse and provide the
same information as you would to HMC.
Incident CommanderIncident Commander
Develop a “Incident action plan” necessary to control the incident.
Establish a Medical Group or branch if needed. Ensure that adequate resources are requested for
both incident manpower and transport capabilities. Direct incoming resources Establish Command post/location and necessary
staging /base areas
Incident Management Incident Management Considerations:Considerations:Is “Gross Decon” and “Lock Down”
notification for hospitals needed ?Buses for shelter and patient transport.Crowd control, separating injured from non.Separate walking wounded from non
ambulatory patients.Separate tactical channel for medical
Gross Decon ProcedureGross Decon Procedure
I.C. establishes “gross decon group”Location: prior to funnel point.Once clean, patient is given a Tyvek suit.Disposable blanket if Back Boarded.Attach white flagging tape to wrist. Proceed to funnel point or green holding
area.
Medical Group/Branch Medical Group/Branch Supervisor Supervisor Filled by a “Medical Services Officer”or first in
Medic Unit officer. Responsible for the over all coordination of the
medical group and Hospital control Recommend early activation of Hospital control Ensure proper resources and manpower for the
medical group. Responsible for accountability
Medical GroupMedical Group
Medical Branch vs. Medical Group
Medical group supervisor
Triage Team Leader Treatment Team
Leader
Transportation Team Leader / ambulance staging manager
Morgue Team Leader
Triage Team LeaderTriage Team Leader
Filled by a Company Officer Accountable for litter barriers and equipment for
back boarding. Responsible for setting up a funnel point Responsible for proper triage including
numbering/flagging of patients Responsible for clearing Patients after gross
deacon needs are complete prior to treatment area.
Funnel Point ProcedureFunnel Point Procedure
V shape set up with saw horses, and a white flag to identify the funnel point.
Pre number treatment tags prior to Patients arriving.
Use division numbers for multiple funnel points. Re-triage “ Safety Net” Mark the treatment card, and patients forehead,
cheek or arm. Attach the tag to the colored tape
Treatment Team leaderTreatment Team leader
Filled by driver of first in medic Unit Sets up Treatment area using supplies from Medic
Units and MSU vehicles. Responsible for the over all treatment in all areas. Appoints treatment area leaders. Ensure adequate resources and proper
documentation is complete on each tag. Coordinates Pt. Loading with Transport.
Transport Team LeaderTransport Team Leader
Filled by experienced EMT, Medic or MSO Responsible for the loading, transporting and
accountability of all patients. Coordinates the destination with Hospital Control. Ensures proper transport resources. Documents all information on a tracking form
using an aid. Consider using an ambulance supervisor
Hospital ControlHospital Control
Utilize cell phones or 800 radiosMake contact with HMC Charge nurse.Transport Team leader advises them of the
condition of the patient. Hospital control advises to which hospital to transport to.
Hospital controls calls ahead, not the unit transporting.
Communication ProblemsCommunication Problems
If no phone access, use the following guidelines.
First 10 patients go directly to HMC 1 or 2 red patients may be sent to other
regional level 3and 4 trauma centers. Use caution transporting to local hospitals.
They may be inundated with self-directed patients.
Ambulance stagingAmbulance staging
Separate from manpower staging.Assign a Staging manager. Consider using
the Ambulance supervisor for that.All personnel stay with their vehiclesPosition units in staging to allow easy
access to the transport post.
Morgue Team LeaderMorgue Team Leader
Filled by an EMT, P.D. or KC M.E.Responsible for scene security of the
deceased. i.e.. personal effectsCoordinates duties with Police and the
Medical Examiner.Documents Morgue activitiesIf body is moved, mark the spot with a flag.
First Arriving UnitFirst Arriving Unit
Size-up the incident. MCI Yes or No? Announce you have an MCI to incoming
resources Call for additional resources. Consider the need
for specialty equipment such as an MSU vehicle. Establish command. BE Command Make assignments for incoming companies. Base units. Secure ingress and egress routes. Initiate triage
Triage EquipmentTriage Equipment
Triage Belt with triage tape with red, yellow, green, black/white rolls.
First Aid Bag attached to belt to provide 5 pressure dressings.
Two inch Tape Marker “water resistant”
Triage CriteriaTriage Criteria
30 seconds per patientUsing the ABC or RPM approach.Awake / AirwayBreathing Circulation, “presence of a radial pulse”Attach the proper triage colored tape to the
wrist. Document onto a piece of 2” tape.
Harvesting Patients:Harvesting Patients:
Recommended four litter barriers per back board for an adult patient.
Recommended two litter barriers per back board for a pediatric patient
Three straps per board for an MCI Duct Tape may be used in place of cloth straps. Large resources needed for litter barriers. Labor
intensive.